In Texas, Medicaid pays dentists for orthodontics per procedure, instead of a lump sum for the “finished mouth” of straight teeth.

This has made Medicaid orthodontia a lucrative dental business in Texas.

WFAA-TV of Texas has been investigating this story for the last six months and has uncovered hundreds of millions of dollars of questionable Medicaid spending on dental braces for children in Texas. Their news reports prompted federal investigators to now audit the Texas Health and Human Services Commission, which controls the Medicaid funds.

According to the WFAA website –

In a letter to the state, the Inspector General says it will examine the “authorization process for orthodontic treatment” under Texas Medicaid. “The objective of our audit,” the letter continues, “is to review the State’s controls to ensure that only medically necessary orthodontic cases are paid.” The time period covered by the audit is September 1, 2008 through May 28, 2011.

The new station’s investigation revealed that during that period, Texas taxpayers spent $424 million on orthodontic braces for children under Medicaid. Taxpayers spent $100 million in 2008, $140 million in 2009, and $184 million in 2010, state records show.

Texas dentist, Dr. Christine Ellis, who teaches at UT Southwestern Medical Center, has twice traveled to Washington in an attempt to convince lawmakers to scale back Texas Medicaid orthodontics payments and divert funds for more pressing dental needs.

Her attempts fell on deaf ears. According to the WFAA-TV article, Ellis said, “There’s no response. No one is putting the brakes on this thing.”

Billy Millwee of the Texas Health and Human Services Commission is now telling WFAA-TV that if taxpayers money has been lost, the Attorney General might take action to get it back. He went on to say that Texas will have a new managed care Medicaid dental program beginning next spring.

Given that one-third of American adults are obese, and another third are overweight, it’s no wonder that weight-loss treatments are big business. One company is addressing the market with a dental device that uses rubber bands to restrict opening of the jaw. (It’s rather like getting your jaw wired shut, but easily reversible.)

The concept started in Europe. An overweight Dutch man was unwilling to get his jaw wired shut since he’s a singer in a band. He worked with an orthodontist to develop the original prototype. Initial tests in Europe have been promising, and the company (Small Bite Inc.) hopes to begin US trials soon.

This survey asked dentists how frequently their patients are referred back after being sent out for treatment by specialists. The clear majority said they always or almost always got their patients back.

Dentists reported that prosthodontists were the worst offenders when it comes to not referring patients back. There were also complaints about pediatric dentists and periodontists. Dentists were happiest with oral surgeons, orthodontists, and endodontists.

Here are some comments from dentists about specialist referrals…

“Periodontists only have incoming phone lines. They never refer back.” (Arizona dentist)

“Building a good relationship with your specialists is critical. Specialist referrals are our second greatest source of new patients, after existing patient referrals.” (Pennsylvania cosmetic dentist)

The Texas Health and Human Services Commission, which administers Medicaid in Texas for dental braces, has filed a request to be reimbursed for $7.5 million in alleged fraudulent claims it paid to Amarillo orthodontist Dr. Michael Goodwin.

Federal authorities also moved to seize the commercial and personal bank accounts of Dr. Goodwin and his wife as part of a probe linked to a Medicaid fraud scheme, according to the Amarillo Globe-News.

In 2008, Dr. Goodwin became an individual Medicaid provider, which allowed him to bill Medicaid only for services personally provided by the orthodontist.

Soon after the change, the Amarillo orthodontist was reported as scheduling up to 400 Medicaid patients a day and allegedly billing the government for orthodontic treatment he did not perform. The Globe-News further reports that patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

In 2009 the Texas Attorney General’s Office’s Medicaid Fraud Control Unit was alerted to the fact that Goodwin was likely billing Medicaid for work done by dental assistants, who worked on dental patients that state law prohibits them from doing “at Goodwin’s direction and without his direct supervision while Goodwin was out of town, away from the office or even while present in the office,” according to an affidavit for the case.

The affidavit further states that Dr.Goodwin scheduled patients in 10-minute increments, “causing pressure for assistants to practice dentistry quickly” and eventually billed Medicaid for their work.

It goes on to outline the fact that Dr. Goodwin would fly from Texas to dental offices in Indiana almost every month, while billing Medicaid for orthodontic patient services in Amarillo on dates when flight records showed he was clearly in Indiana.

The majority of Goodwin’s patients were Medicaid recipients with some reporting that figure could be as high as 95% of his dental practice.

Unfortunately, this is not a new dental braces trend in Texas …

Last June, The Wealthy Dentist reported that in 2010, Texas spent $184 million on Medicaid orthodontics — more than the rest of the United States combined. Dentist Richard Malouf’s All Smiles Dental Centers of Texas collected $5.4 million from Medicaid orthodontics. Since that time, All Smiles’ Medicaid orthodontics billings nearly doubled to $10.2 million.

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